| BackgroundNowadays,the scarcity of skilled nurses is being highlighted as one of the biggest obstacles to achieving health system effectiveness both in developed and developing countries.China also faces the severe challenges of nursing shortages.It was estimated that there are 3.51 million registered nurses in China in 2016,and the ratio of doctors and nurses was only 1:1.10.This ratio is far from 1:1.25 which is put forward by the Outline of National Medical and Health Service System(2015-2020).Mal-distribution of nursing human resources is also an intractable problem in China.From 2010 to 2015,registered nurses of per 1000 population have increased from 3.09 to 4.75 in urban areas and only increased from 0.89 to 1.50 in rural areas.and the gap between urban and rural areas is prominent.In addition,limited quality and brain drain of nursing human resources are also intractable problems in China.The unreasonable allocation of nursing human resources will increase the workload and work pressure of existing nurses,which will not be conducive to healthy sustainable development of medical and health services.Medical colleges have expanded enrollment levels,but the shortage of nurses still remains a severe problem in China,especially in rural areas.Therefore,there is an urgent need for policymakers to explore the job preferences of the undergraduate nursing students,attract and retain them to rural areas.ObjectiveThe purpose of this study is to learn more about the knowledge of employment situation and current employment intention among final year undergraduate nursing students,and find out what job attributes affect their job choices using a discrete choice experiment(DCE).The findings of the study will be conducive to better career guidance for schools,and provide valuable information for policymakers to design effective strategies to attract more nursing students into nursing work,especially in rural areas,to consolidate,stabilize,enrich and develop construction of nursing teams.Specific goals include:(1)Learn more about the knowledge of nursing professions and occupations,the knowledge of employment situation and prospects,and current employment intention among final year undergraduate nursing students,(2)Establishing the job attributes and corresponding levels(3)Exploring the job preferences of the final year undergraduate nursing students,find out what job attributes affect their job choices,and providing valuable information for policymakers to design effective strategies.MethodsThis study was carried out in Weifang Medical University,Binzhou Medical University,Jining Medical University and Taishan Medical College in Shandong Province among 554 final year undergraduate nursing students.We investigated their knowledge of employment situation and current employment intention,and explored their job preferences using a DCE.The DCE mainly includes three sections.Based on literature reviews,in-depth interview,focus group discussions as well as discussions with two senior health economists who are experts on DCEs,six attributes and their levels were finally included within the DCE.The six job attributes included location,monthly income,bianzhi(which can be loosely regarded as state administrative staffing),career development and training opportunity,work environment and working strength.Next,a D-efficient design was used to generate a more manageable 24 scenarios(which were further blocked into 2 versions)using the Ngene software.The choice sets 3 was included twice as choice set 13 within each version to check the internal consistency.Finally,based on random utility model,the DCE data was analyzed using the mixed logit models.Based on the results of mixed logit models,willingness to pay(WTP)was calculated,that is,the relative monetary value that respondents place on a certain attribute level.We also conducted a simulation study to predict that the uptake rates of the undergraduate nursing students for rural jobs change as levels of job attributes are changed(policy interventions).ResultsOnly 5.3%of the nursing students chose nursing profession based on their interest for it,however,approximately half of the students had a positive attitude toward nursing profession after four years of study.29.4%of the students believed that the nursing occupation is less respected by people.About half of the students thought that the problem of getting along with patients and their families is the biggest challenge for nurses.Most of students were positive about employment(69.0%),and dreamt to work in tertiary hospitals(85.4%).The main regression results showed that all attributes were statistically significant and were of the expected sign.The final year undergraduate nursing.students expressed highest stated preferences for a job with light working strength(β = 1.013,P<0.01),followed by excellent work environment(β = 0.760,P<0.01).Although location in city had a positive effect for the respondents(β= 0.339,P<0.01),it did not appear to be as important as the other attributes.The results of WTP showed that the undergraduate nursing students were willing to pay RMB 2096.2 monthly income for a job with light working strength than a job with heavy working strength.However,they only put a value of RMB 702.4 per month on the work in city,as compared to the work in township or village.Apart from the attribute of location,the preferences for other job attributes between different subgroups were relatively similar.Students who came from county or city,were the only child,and students whose family income were more than RMB 50000 were willing to pay more monthly income for a job in city.There were different job choices under different policy interventions.If monthly income increased from RMB 2000 to RMB 8000,the probability of choosing a rural job would increase by 89.6%.Improving working strength from heavy to light,work environment from poor to excellent,career development and training opportunity from insufficient to sufficient and offering bianzhi would increase the probability of taking a rural job by 46.7%,36.3%,31.5%and 31.3%,respectively.Conclusions and SuggestionsThe undergraduate nursing students had lower recognition for nursing profession and nursing occupation.They thought that the problem of getting along with patients and their families is the biggest challenge for nurses.Most of the students had positive attitude toward employment,but their employment expectations were too high.Therefore,medical universities/colleges should pay more attention on the development of their own nursing profession to improving the attraction of nursing profession.The vocational guidance should run through the whole nursing education and make them keep correct understanding for nursing profession and nursing occupation.In addition,medical universities/colleges should change their traditional employment idea,encourage them to work in basic medical and health institutions,which is benefit to stabilize the construction of basic nursing teams.All of the six attributes including economic and non-economic factors significantly affected the job choices of the students.They preferred a job with higher monthly income,light working strength,excellent work environment,sufficient opportunity for career development and training,offering bianzhi and located in city.Therefore,policymakers should take into account their job preferences.Apart from raising their monthly income,it is necessary to consider the influence of non-economic factors,and formulate efficient packages of policy interventions based on the actual conditions.Among all non-economic factors,the most important attribute for the undergraduate nursing students was light working strength,followed by excellent work environment,and the least important attribute was working in the city.Medical and health institutions should provide more systematic and standardized training,improve their service ability and working efficiency,shorten working time,and reduce working strength to some extent.In addition,medical and health institutions should pay more attention on their own configuration of infrastructure,medical equipments and medicines,and their own construction of hospital management system and organizational culture.These measures will enhance internal coherence,and provide staff with more harmonious work environment.The disparity in WTP among different subgroups was mainly showed in the attribute of location.Among them,there was the largest disparity of WTP among nursing students who came from different places.Therefore,medical universities/colleges should train some nursing students who have a rural background,and increase the content of rural health services among their teaching process.In addition,higher monthly income is the most important factors to attract nursing students working in rural areas.Improving monthly income should be a priority of policymakers,but they should focus on other policy interventions after raising monthly income to a certain level. |
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